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Context Eye care is important, but it is not always promoted as much as other aspects of health. A visit to an eye care professional is made when need, stimulus, access and availability exist. Data and methods Data from cycles 5 and 6 (2016 to 2019) of the Canadian Health Measures Survey were used. Analyzed variables were related to sociodemographic characteristics, general health, behaviour and eye health. Estimates were obtained using survey weights, and 95% confidence intervals were obtained with bootstrap weights. Results From 2016 to 2019, 75% of people diagnosed with diabetes visited an eye care professional during the previous year. For people not diagnosed with diabetes, the rate varied, at 57% for those aged 6 to 18 years, 40% for those aged 19 to 64, and 63% for those aged 65 to 79. For those aged 6 to 64, wearing glasses and having access to a family doctor were the main factors associated with a visit to an eye care professional in the previous year. For those aged 65 to 79, cataracts, sex, marital status and self-perceived quality of life were the most significant factors. Interpretation Although wearing glasses or having eye diseases was associated with a visit to an eye care professional, this study revealed additional emerging associated factors: access to a family doctor for people aged 6 to 64, and an excellent or very good self-perceived quality of life for those aged 65 to 79. [ABSTRACT FROM AUTHOR]

Context Eye health is an indicator of health in general. Few studies on eye health have been done in Canada, and none of them covered several years of data. Data and methods Data from the Canadian Community Health Survey for most years from 2000 to 2020 were used. Eye health was analyzed, by year, sex and age, as well as by immigrant status, the highest level of education in the household and the income quintile of the household. Estimates were obtained using survey weights, and 95% confidence intervals were obtained with bootstrap weights. Results In 2020, the proportion of the population that reported having good vision without correction was about 75% among youth aged 12 to 19 years for both sexes. This proportion was considerably lower for those aged around 45 to 49 years and was about 25% for those aged 55 years or older. Self-reported good vision without correction improved from 2000/2001 to 2020, except for those aged 20 to 39 years old. Every year, fewer females than males reported having good vision without correction. Interpretation Self-reported eye health generally improved during the period of this study. Limitations of the survey arise from the fact that it uses self-reported data. Moreover, the survey underwent important changes in 2015 that could limit the comparability of data during the period of the study. However, the large number of years included in the study and the stability of the results validate the conclusions. [ABSTRACT FROM AUTHOR]

Abstract Background Computer simulation models are used increasingly to support public health research and policy, but questions about their quality persist. The purpose of this article is to review the principles and methods for validation of population-based disease simulation models. Methods We developed a comprehensive framework for validating population-based chronic disease simulation models and used this framework in a review of published model validation guidelines. Based on the review, we formulated a set of recommendations for gathering evidence of model credibility. Results Evidence of model credibility derives from examining: 1) the process of model development, 2) the performance of a model, and 3) the quality of decisions based on the model. Many important issues in model validation are insufficiently addressed by current guidelines. These issues include a detailed evaluation of different data sources, graphical representation of models, computer programming, model calibration, between-model comparisons, sensitivity analysis, and predictive validity. The role of external data in model validation depends on the purpose of the model (e.g., decision analysis versus prediction). More research is needed on the methods of comparing the quality of decisions based on different models. Conclusion As the role of simulation modeling in population health is increasing and models are becoming more complex, there is a need for further improvements in model validation methodology and common standards for evaluating model credibility.

Introduction: The objective of our study was to present model-based estimates and projections on current and future health and economic impacts of cerebral palsy in Canada over a 20-year time horizon (2011-2031). Methods: We used Statistics Canada's Population Health Model (POHEM)-Neurological to simulate individuals' disease states, risk factors and health determinants and to describe and project health outcomes, including disease incidence, prevalence, life expectancy, health-adjusted life expectancy, health-related quality of life and health care costs over the life cycle of Canadians. Cerebral palsy cases were identified from British Columbia's health administrative data sources. A population-based cohort was then used to generate the incidence and mortality rates, enabling the projection of future incidence and mortality rates. A utility-based measure (Health Utilities Index Mark 3) was also included in the model to reflect various states of functional health to allow projections of health-related quality of life. Finally, we estimated caregiving parameters and health care costs from Canadian national surveys and health administrative data and included them as model parameters to assess the health and economic impact of cerebral palsy. Results: Although the overall crude incidence rate of cerebral palsy is projected to remain stable, newly diagnosed cases of cerebral palsy will rise from approximately 1800 in 2011 to nearly 2200 in 2031. In addition, the number of people with the condition is expected to increase from more than 75 000 in 2011 to more than 94 000 in 2031. Direct health care costs in constant 2010 Canadian dollars were about $11 700 for children with cerebral palsy aged 1-4 years versus about $600 for those without the condition. In addition, people with cerebral palsy tend to have longer periods in poorer health-related quality of life. Conclusion: Individuals with cerebral palsy will continue to face challenges related to an ongoing need for specialized medical care and a rising need for supportive services. Our study offers important insights into future costs and impacts associated with cerebral palsy and provides valuable information that could be used to develop targeted health programs and strategies for Canadians living with this condition. [ABSTRACT FROM AUTHOR]

Introduction: The objective of our study was to present model-based estimates and projections on current and future health and economic impacts of multiple sclerosis (MS) in Canada over a 20-year time horizon (2011-2031). Methods: Using Statistics Canada's Population Health Microsimulation Model (POHEM) framework, specifically the population-based longitudinal, microsimulation model named POHEM-Neurological, we identified people with MS from health administrative data sources and derived incidence and mortality rate parameters from a British Columbia population-based cohort for future MS incidence and mortality projections. We also included a utility-based measure (Health Utilities Index Mark 3) reflecting states of functional health to allow projections of health-related quality of life. Finally, we estimated caregiving parameters and health care costs from Canadian national surveys and health administrative data and included them as model parameters to assess the health and economic impact of the neurological conditions. Results: The number of incident MS cases is expected to rise slightly from 4051 cases in 2011 to 4794 cases per 100 000 population in 2031, and the number of Canadians affected by MS will increase from 98 385 in 2011 to 133 635 in 2031. The total per capita health care cost (excluding out-of-pocket expenses) for adults aged 20 and older in 2011 was about $16 800 for individuals with MS, and approximately $2500 for individuals without a neurological condition. Thus, after accounting for additional expenditures due to MS (excluding out-of-pocket expenses), total annual health sector costs for MS are expected to reach $2.0 billion by 2031. As well, the average out-of-pocket expenditure for people with MS was around $1300 annually throughout the projection period. Conclusion: MS is associated with a significant economic burden on society, since it usually affects young adults during prime career- and family-building years. Canada has a particularly high prevalence of MS, so research such as the present study is essential to provide a better understanding of the current and future negative impacts of MS on the Canadian population, so that health care system policymakers can best plan how to meet the needs of patients who are affected by MS. These findings also suggest that identifying strategies to prevent MS and more effectively treat the disease are needed to mitigate these future impacts. [ABSTRACT FROM AUTHOR]

Background: This study summarizes the linkage of the Canadian Community Health Survey (CCHS) and the Canadian Mortality Database (CMDB), which was performed to examine relationships between social determinants, health behaviours and mortality in the household population. Data and methods: The 2000/2001-to-2011 Canadian Community Health Surveys were linked to the 2000-to-2011 CMDB using probabilistic methods based on common identifiers (names, date of birth, postal code and sex) for eligible respondents (85%; n = 614,774). Mortality records from January 1, 2000 through December 31, 2011 for people aged 12 or older were eligible for linkage (n = 2.774 million). The linkage was enhanced with information from the Historical Tax Summary File. Quality assessment consisted of internal and external validation. Cox survival analysis (age-adjusted) was conducted to estimate hazard ratios (HRs) associated with selected health behaviours. Results: Overall, 5.3% of eligible CCHS respondents linked to a mortality record; false positive and false negative rates were 0.04% and 2.43%, respectively. Linkage rates were higher among males (5.8%) and people aged 75 or older (20.2%), reflecting known mortality risks. Survival analyses confirmed elevated mortality risk associated with heavy (HR 2.36, CI 1.84, 2.89) and light smoking (HR 1.91, CI 1.52, 2.33), compared with not smoking; underweight and obesity, compared with normal and overweight; low fruit and vegetable consumption; and lack of physical activity. Interpretation: Linking health behaviour information from the CCHS to mortality data from the CMDB allows for a greater understanding of modifiable determinants of mortality. [ABSTRACT FROM AUTHOR]

Background: As part of a program of the first National Population Health Study of Neurological Conditions launched in 2009, a series of microsimulation models of neurological conditions (called POHEM-Neurological meta-model) was developed to project health and economic impacts of seven neurological conditions (NCs)--Alzheimer's disease and other dementias, cerebral palsy, epilepsy, multiple sclerosis, Parkinson's disease, traumatic brain injury, and traumatic spinal cord injury--over a 20-year horizon. Data and methods: The common framework of the seven models al lows for dynamic, cont inuous- time, discrete-event simulation of synthetic large populations in which persons are subject to the risk of developing the NC under study and are assigned a value of functional health and a probability of receiving a caregiver and of entering long-term care. Calculations for transitions are done every year over the life course, and costs are accumulated throughout the life of the synthetic person. The need to reconcile empirical estimates of incidence and mortality with prevalence required implementation of "cure" parameters for two of the NCs. Results: The POHEM-Neurological meta-model integrates the latest Canadian microdata on neurological conditions and satisfies most criteria for validation of microsimulation models, including conceptualization, computer implementation, assessment of output plausibility, and comparison with external data. Limitations include an absence of risk factors and the lack of uncertainty measures. Interpretation: The POHEM-Neurological meta-model has been useful for projections of health and economic impacts of NCs on persons affected and their caregivers, and allows for comparison of specific scenarios to the base case. [ABSTRACT FROM AUTHOR]

Background: Reductions in preventable risks associated with cardiovascular disease have contributed to a steady decrease in its incidence over the past 50 years in most developed countries. However, it is unclear whether this trend will continue. Our objective was to examine future risk by projecting trends in preventable risk factors in Canada to 2021 . Methods: We created a population-based microsimulation model using national data on births, deaths and migration; socioeconomic data; cardiovascular disease risk factors; and algorithms for changes in these risk factors (based on sociodemographic characteristics and previous cardiovascular disease risk). An initial population of 22.5 million people, representing the Canadian adult population in 2001, had 13 characteristics including the risk factors used in clinical risk prediction. There were 6.1 million potential exposure profiles for each person each year. Outcome measures included annual prevalence of risk factors (smoking, obesity, diabetes, hypertension and lipid levels) and of co-occurring risks. Results: From 2003 to 2009, the projected risks of cardiovascular disease based on the microsimulation model closely approximated those based on national surveys. Except for obesity and diabetes, all risk factors were projected to decrease through to 2021. The largest projected decreases were for the prevalence of smoking (from 25.7% in 2001 to 17 .7% in 2021) and uncontrolled hypertension (from 16.1% to 10.8%). Between 2015 and 2017, obesity was projected to surpass smoking as the most prevalent risk factor. Interpretation: Risks of cardiovascular disease are projected to decrease modestly in Canada, leading to a likely continuing decline in its incidence. [ABSTRACT FROM AUTHOR]

Background Few national studies of hospitalizations due to injuries among the First Nations population have been conducted. Data and methods Based on 2004/2005 to 2009/2010 data from the Discharge Abstract Database, this study examines associations between unintentional injury hospitalizations, socio-economic status and location relative to an urban core in Dissemination Areas (DAs) with a high percentage of First Nations identity residents versus a low percentage of Aboriginal identity residents. Results Unintentional injury hospitalization rates were higher in the less affluent and the most remote DAs. When DAs with the same socio-economic status and location were compared, the risk of hospitalizations was greater in high-percentage First Nations identity DAs relative to low percentage Aboriginal identity DAs. Interpretation Socio-economic conditions and remote location accounted for some, but not all, of the differences in unintentional injury hospitalizations between high-percentage First Nations identity and low-percentage Aboriginal identity DAs. This suggests that characteristics not measured in this analysis-such as environmental, behavioural or other factors-play an additional role in DA-level unintentional injury hospitalization risk. [ABSTRACT FROM AUTHOR]

Background Statistics Canada has initiated a series of data linkages of Census of Population long form and health outcome data. These linked data lack risk factor information. This study assesses the feasibility of using statistical modelling techniques to assign smoking status to census respondents. Data and methods The 2000/2001 Canadian Community Health Survey (CCHS) was used to develop age-/ sex-specific predictive models to model smoking status based on variables available on the 1991 Census. The 2002/2003 CCHS was used to validate the modelled variable. Data from the 2002/2003 CCHS linked to data from the Hospital Morbidity Database (2001/2002 to 2004/2005) were used to evaluate the use of modelled versus self-reported smoking status on smoking-related hospitalizations. Results For the current daily smoker models, income, education, marital status, dwelling ownership and region of birth were significant predictors. For the never smoker models, marital status, dwelling ownership, Aboriginal identity and region of birth were significant predictors. Modelled current daily smoker status was associated with increased odds of smoking-related hospitalization, compared with being a never smoker, even when adjusting for covariates. Interpretation This study demonstrates the feasibility of using statistical modelling techniques to assign smoking status to census data, provided socio-economic and identity information is available. [ABSTRACT FROM AUTHOR]

Data from the Discharge Abstract Database of the Canadian Institute for Health Information were used to examine acute care hospital days for patients with a mental condition coded as the most responsible diagnosis or a comorbid diagnosis. In 2009/2010, patients with a mental diagnosis represented 11.8% of people who had been hospitalized and 25.5% of acute care hospital days. Those for whom the mental condition was the most responsible diagnosis accounted for 9.0% of hospital days (1.2 million), and those with a comorbid mental diagnosis accounted for 16.5% of hospital days (2.3 million). Mental diagnoses were often associated with physical conditions. The average hospitalization with a mental diagnosis was two and a half times as long as the average for hospitalizations without a mental diagnosis. About one-quarter of hospital days with a mental diagnosis were designated as alternate level of care days. [ABSTRACT FROM AUTHOR]

Background: Computer simulation models are used increasingly to support public health research and policy, but questions about their quality persist. The purpose of this article is to review the principles and methods for validation of population-based disease simulation models. Methods: We developed a comprehensive framework for validating population-based chronic disease simulation models and used this framework in a review of published model validation guidelines. Based on the review, we formulated a set of recommendations for gathering evidence of model credibility. Results: Evidence of model credibility derives from examining: 1) the process of model development, 2) the performance of a model, and 3) the quality of decisions based on the model. Many important issues in model validation are insufficiently addressed by current guidelines. These issues include a detailed evaluation of different data sources, graphical representation of models, computer programming, model calibration, between-model comparisons, sensitivity analysis, and predictive validity. The role of external data in model validation depends on the purpose of the model (e.g., decision analysis versus prediction). More research is needed on the methods of comparing the quality of decisions based on different models. Conclusion: As the role of simulation modeling in population health is increasing and models are becoming more complex, there is a need for further improvements in model validation methodology and common standards for evaluating model credibility. [ABSTRACT FROM AUTHOR]

Background Health-adjusted life expectancy is a summary measure of population health that combines mortality and morbidity data into a single index. This article profiles differences in health-adjusted life expectancy across income categories for a representative sample of the Canadian population. Data and methods Mortality data were obtained from the 1991-2001 Canadian census mortality follow-up study, which linked a 15% sample of the 1991 adult non-institutional population with 11 years of death records from the Canadian Mortality Data Base. Information on morbidity was obtained from the Health Utilities Index Mark 3 instrument on the 2000/2001 Canadian Community Health Survey. The Sullivan method was used to compute health-adjusted life expectancy for national deciles of population ranked by income. Main results For both sexes, and with few exceptions, a nearly linear gradient across income deciles emerged for health-adjusted life expectancy at age 25. Compared with people in higher-income deciles, those in lower-income deciles had fewer years of health-adjusted life expectancy. These disparities were substantially larger than those revealed by life expectancy alone. Interpretation These findings highlight the generally worse health-related quality of life of lower-income groups. The results demonstrate that assessments of socio-economic disparities in health should include the effects of both mortality and morbidity. [ABSTRACT FROM AUTHOR]

This article examines geographical variations in 30-day revascularization rates and 30-day in-hospital mortality rates for Canadian heart attack (acute myocardial infarction) patients. The data are from the Health Person-Oriented Information Database and pertain to health regions with at least 100,000 population in seven provinces for the years 1995/1996 and 2003/2004. Revascularization rates rose in all health regions between these years, and mortality rates dropped in most, but not all, regions. Generally, health regions with high revascularization rates had lower mortality rates. However, some regions with high revascularization rates had relatively high mortality rates, and some with relatively low revascularization rates achieved relatively low mortality rates. These results raise important questions about the overall efficiency of health care in Canada, and suggest that better data are needed to support research on explaining the wide geographical variations in treatment and survival rates for heart attack patients. [ABSTRACT FROM AUTHOR]

Background A selective approach may be used in an ecological study where the aim is to choose a subset of units of analysis (UAs) and produce interpretations about a population of interest (PI) based solely on those UAs. The results for the PI will be reliable if that population is concentrated in the selected UAs and rare in other UAs. This article presents a graphical tool that helps determine whether these conditions are satisfied. Data and methods Data on the Inuit and Métis ancestry populations from the 1996 Census of Canada are used for illustrative purposes. Based on a classification statistics table, a concentration-coverage curve can be created for a given PI. The shape of the curve indicates whether it is possible to choose a threshold that will yield both adequate concentration and adequate coverage of the PI. Results The concentration-coverage curve shows that, among Aboriginal peoples living in rural areas, the Inuit population is classifiable, but the Mé tis population is not. Interpretation This method can be applied to any ecological study focussing on the proportion of individuals sharing a single characteristic defined by a binary variable. [ABSTRACT FROM AUTHOR]

Objectives Because of a lack of Aboriginal identifiers on death registrations, standard data sources and methods cannot be used to estimate basic health indicators for Inuit in Canada. Instead, a geographic-based approach was used to estimate life expectancy for the entire population of Inuit-inhabited areas. Data sources The data are from the Canadian Mortality Database and the Census of Canada. Analytical techniques Areas where at least 33% of residents were Inuit were identified, based on census results. Vital statistics death records for 1989 through 2003 and census population counts for 1991, 1996 and 2001 were used to compute abridged life tables for the Inuit-inhabited areas in each of the three 5-year periods centered around those census years. Main results In 1991, life expectancy at birth in the Inuit-inhabited areas was about 68 years, which was 10 years lower than for Canada overall. From 1991 to 2001, life expectancy in the Inuit-inhabited areas did not increase, although it rose by about two years for Canada as a whole. As a result, the gap widened to more than 12 years. Life expectancy in the Inuit-inhabited areas was generally highest in the Inuvialuit region (Northwest Territories) and Nunavut (Territory), followed by Nunatsiavut (Labrador) and Nunavik (Quebec). While these results are not specific to the Inuit population, such geographic-based methods can be used with any administrative datasets that include postal codes or municipal-level locality codes. [ABSTRACT FROM AUTHOR]

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Objectives Longitudinal analyses were used to examine the rate of change of self-reported weight among adults over two-year intervals from 1996/1997 to 2004/2005, and to determine if the pace at which Canadians' weight is changing has slowed down or accelerated. Associations between weight change and sex, age group and body mass index (BMI) category are also examined. Data sources The data are from the 1996/1997 through 2004/2005 National Population Health Survey, Analytical techniques Average weight changes over two-year intervals were calculated by sex, age group and BMI category. Linear regression was used to determine if the rate of weight change was stable, increased or decreased over time. Main results From 1996/1997 to 2004/2005, Canadian adults gained, on average, 0.5 to 1 kg per two-year period. Although people aged 18 to 64 continued to gain weight, the amount gained decreased significantly in the most recent interval, 2002/2003 to 2004/2005. This downturn is due, in part, to a significant decrease in the proportion of men gaining weight during that period. However, among people who gained weight, the amount gained in two years increased over the entire eight-year period. [ABSTRACT FROM AUTHOR]